The Use of Peers in Access and Retention Programs Focused on

THE USE OF PEERS IN ACCESS AND
RETENTION PROGRAMS FOCUSED
ON HIV+ WOMEN OF COLOR
Speaker: Rachael Peters, MPH, MSW
Speaker: Tina Henderson, Ph.D.
Speaker: Marisol Gonzalez, R.N.
Moderator: Arthur E. Blank, Ph.D.
A HRSA SPNS Initiative:
Enhancing Access to and Retention in Quality HIV Care for Women of Color
Introduction to Initiative
and Workshop
Peer Outreach Workers Engagement and Retention
Program
SUNY Downstate Medical Center
Brooklyn NY
Rachael Morgan Peters, MPH, LMSW, POWER Program Coordinator, SUNY
Downstate Medical Center
INTERVENTION
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Added peers to an already existing functioning network
of HIV care providers
Relies on the peer-case manager dyad and strength of
the network
Peers are HIV+ women who are hired as part of the
clinical team
Peers reach out to women who are:
› Newly diagnosed with HIV
› Contact clients who have dropped out of care
› Work with clients who are at-risk for dropping out
(unstable housing or other unstable social factors
such as family and partner issues)
› Connect with clients who are transitioning from
adolescent to adult care
PEER ROLE
“A Peer Outreach Worker gives support. Our
clients see that we are going through some
of the same things they are and they are
inspired.” –Peer Outreach Worker
“I am the bridge to all the services at our
clinic.”
-Peer Outreach Worker
INTERVENTION ACTIVITIES
Peers provide support on an individual level at
client’s homes and at clinic
 Escort clients to services
 Remind clients of appointments
 Assist with transportation to appointments
 Collaborate with clinical team to ensure client
remains connected to care
 Use Motivational Interviewing techniques to
help women to seek care

PEER TRAINING
Peers trained as both outreach workers and
as researchers
 During formal training times, weekly
individual supervision, and weekly ongoing
group supervision

PEER TRAINING
4 areas of training
Peer Role
1.
Engagement techniques
Safety measures
Motivational interviewing
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HIV 101 and other information/education based
topics
2.
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Domestic violence
Substance abuse
Workplace Basics
3.
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What to wear to work
Evaluation Implementation
4.
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Human subjects research training
Survey review
PEER TRAINING – EVALUATION
IMPLEMENTATION
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Research with Human Subjects training
Gaining Consent
Survey implementation is more difficult for peers
with lower literacy, but possible with:
 Lengthy training time
 Role play
 Culture of group feedback
 Consistent monitoring and review
 Flexibility & Support
Challenge of focus
Professional Challenges
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Hiring
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Right fit
Salary/Benefits
Training
 Supervision
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Documentation
Boundaries
Over identifying with clients
PERSONAL CHALLENGES

Disclosure
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Stress
 Job
related
 Personal Stress
 Medical Leave
QUALITATIVE FEEDBACK
“The fact that you have somebody that you can call, to talk to, when
you need somebody to assist you, somebody who knows what you
are going through. Basically, somebody who is going to keep you
on point. Because a lot of females…Well, a lot of people in general
feel down dealing with HIV/AIDS. With that (having a peer), you
have somebody who is your age, going through or has gone
through a similar situation. They can relate.“
“I know that having an extra person on my team, in my corner can
only help where I need to be. “
“You just always have somebody to talk to about anything-even life
experiences. You just have somebody who can relate to you. You
have the case manager there as well, working with the peer, and
they both help you get your information. It’s a good fit and a
benefit—for me. “
•
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HRSA SPNS for funding us
The FACES Network
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HEAT
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M. Perez, J. Bastas, J. Goldberg
Housing Works
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J. Irwin, C. Shepherd, S. Lewis, P. Jones, L. Blackman
Brooklyn Hospital, PATH Center
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•
J. Birnbaum, E. Eastwood, D. Weekes, S. Murphy
W. Blanch, L. Smith, S. Culler, K. Thompson,
Interfaith Medical Center
–
T. Mounsey, J. Lawrence, J. Stultz, S. Ahmed
If you have any further questions about POWER
please contact Rachael Peters, POWER
Program Coordinator
[email protected]
718-221-6136
http://www.heatprogram.org/power.html
LADIES OF DIVERSITY PROJECT (LODI)
PROYECTO DIVERSIDAD DE MUJERES (DIMU)
LODi/DiMu: Peers helping clients
Tina Henderson, PhD, JWCH Institute, Inc.
Ryan White All-Grantee Meeting
November 27-29, 2012
Washington, DC
JWCH INSTITUTE, INC.
Located in Los Angeles, CA
 Federally Qualified Health Center (FQHC)
 21 clinics (store front to full service)
 Service areas- Downtown and other contiguous
health areas.
 Our Mission

LODI/DIMU FRONTLINE TEAM
3 FT Community Health Outreach Workers
 3 PT Outreach Workers
 4 volunteer peer CHOWS (currently)

WORKING
TOGETHER
RECRUITMENT
street outreach
CBO referrals
program referrals
housing facilities
meetings
one on one
CASE MANAGERS
Refer clients who qualify
Work with CHOW on
needs of clients
ENROLLMENT into LODi
Needs assessment/baseline
Assigned a CHOW/peer CHOW
Provide referrals
Case Management
ROLE of CHOW
meet clients on a monthly basis
provide referrals
one on one case management
sessions (ICM)
call or meet with client
educate on medical system
ROLE of PEER
Increase follow-up and tracking
Co-facilitate support groups
Build and increase relationship
with client
be a role model for clients
contribute to our understanding
about the needs of the population
LODI/DIMU PEER CHOWS
1.
2.
Peer CHOWs must qualify with specific
criteria.
7 session training.
• 13 peer CHOWs who have participated
in PEER training (Four cohorts).
• 6 are employed and 1 doing
psychological internship
FINDING & SUPPORTING CLIENTS
FINDING
 Direct street outreach
 Presentations at substance abuse treatment
programs, facilities, transitional homes and other
facilities/ agencies.
 Within and outside agency referrals
 Canvassing housing facilities
 Sit in waiting rooms of SROs and Skid Row Housing
facilities
 Arrange meetings/schedule interviews with CHOWs
 Referrals from other clients
FINDING & SUPPORTING CLIENTS CONT’D
SUPPORTING
 Conduct one on one client support sessions
 Assist clients to doctor’s appointments
 Assist clients with navigating medical system
 Co-facilitate support groups
EXPERIENCES
What Helps You to be a Peer
6
5
4
3
2
1
0
Rating
Shadow ing a verteran
peer or Outreach w orker
Peer Training
Direction from CHOW
My ow n life experiences
Field Experiences
4.67
4.8
4.33
5
3.4
QUOTABLE EXPERIENCES
Lost clients-“Looking for lost clients was very challenging due to the fact that
most do not want to be found and may be still active in their addiction and even
perhaps feel hopeless. I enjoyed the rare occasions when the client had a clear
state of mind and you can see the change in them.”
Outreach-“Peer navigation is greatly needed for newly diagnosed and fallen out
of care clients. I believe they need to have more education on how to access
care and what is patients rights.”
Impactful exp.-“I reached out to a person that was actually walking the street
looking for help. I was at the right place at the right time. I was able to be a
strength and give her hope and knowledge.”
Major challenges- “Lack of housing and fear of people knowing they are HIV.”
LESSONS LEARNED-CHOWS
Keep
it fun and relevant.
Compensation not just money but sense of
pride.
Include them in the process.
Be clear of expectations and their roles.
Evaluation challenge: Keeping track of all of the
support peer CHOWs provide to clients.
LESSONS LEARNED-CLIENTS
Setting goals and accomplishing them.
 Being accepting and providing a form of
stability.
 Medical adherence as a social part of their life.
 Support groups, events, and “feel-good”
activities.
 “Have something to live for- something bigger
than themselves”.

The Ruth M Rothstein CORE Center
Chicago, IL
Project WE CARE
(Women Empowered to Connect And Remain
Engaged in Care)
Marisol Gonzalez, RN, MPH – Principal Investigator
Allison M. Precht, MA, CADC- Project Manager
Susan Ryerson Espino, PhD – Lead Evaluator
Funded by: HRSA: Special Project of National Significance
THE RUTH M. ROTHSTEIN CORE CENTER
CHICAGO, IL
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Cook County Health and Hospitals System – Public “Safety-Net”
Facility
5,000 active patients, 35,000 primary care visits annually
64% African American and 20% Hispanic/Latino
Frequent history of drug use, incarceration
Approximately 1200 women with HIV annually.
An estimated 70-75% of all HIV infected women and 25-30% of HIV
infected children known to be in care in the Chicago area.
PROGRAM PURPOSE

The purpose of the CORE Center Peer Program
is to provide a supportive structure to assist
peers in maintaining their treatment plans and
in developing life, work and coping skills
through the opportunity to participate in CORE
Center operations.
BACKGROUND OF PEER PROGRAM
Developed in 1995 and centralized in 2000
 Part-Time Stipend
 Role models for other consumers
 Participation is a privilege, not a right
 Participation is dependent upon compliance
with personal treatment program and
satisfactory work performance

PROGRAM PRINCIPLES
Performance expectations are clearly stated
and delineated at the start of training
 There are consequences for failing to meet
expectations
 Failure to meet expectations will be addressed
in a supportive non-punitive mode using a
progressive discipline/employee assistance
approach

PEER PROGRAM TRAINING
HIV 101, HIV Timeline, STIs, Hepatitis, TB,
Research, HIV-AIDS & Law, Ryan White Care
Act, etc.
 Return Demonstrations
 10 Minute Group Presentation
 Graduation Ceremony

PROGRAM POLICIES
Qualifications for Peer Program
 Peer Compliance with Treatment Plan
 Code of Conduct
 Confidentiality Agreement
 Disciplinary Procedures/Corrective Action Plan
 Other CORE Center and CCHHS Policies as
applicable
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PEER PROGRAM
CHALLENGES
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Employer, Employee
Relations
Increased Demand for
Peer Services
Funding
Establishing Opportunities
Beyond the Program
Medical/Social Issues
Confidentiality issues
Managing & Maintaining
Healthy Boundaries
SUCCESSES
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Obtainment of Full-time
Employment
Staff Recognition
National Recognition
Patient Recognition
Peers as Part of the Care
Team
Personal Growth
A consulting Psychologist
provides MH services and
monthly workshops
Transition into Peer
Fellowship Program (2012)
FROM PEER TO PATIENT NAVIGATOR
Challenges
 Role Development
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Conceptualized role vs. personnel policies
Challenges defining service tasks in
concrete terms
Role acquisition issues…prefer desk work
rather than advocacy work
Clinic Time/Hospital time/Field visit time = Level
of resources needed varies.
FROM PEER TO PATIENT NAVIGATOR
Challenges Cont’d:
 Role
Differentiation
 Differentiating
other peers.
 Change
PPN from others like case managers and
in Benefits
 Loss
of Medicaid
 Loss of ADAP
 PAID TIME OFF (PTO) insufficient
 High cost of insurance

ALL medical/mental health services must go through
insurance.
FROM PEER TO PATIENT NAVIGATOR
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Successes
Care team beginning to see value of Patient
Navigators (PN) as part of a multi-disciplinary
team
Patient Navigators self-identifying value of
position
Patients asking for their PN
FROM PEER TO PATIENT NAVIGATOR
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Lessons Learned
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Deemphasize evaluation (in future define service
prior to evaluation)
Prioritize service & advocacy roles
Recruit advocates
THANKS!!!!
Peer Educators
 Patient Navigators
 Outreach Workers
 Arianna Smith
 Peter McLoyd
 Allison Precht

Q&A SESSION
THANK YOU